MEDICARE: SAVE GIRLS ON FYER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	007585	CT

General Provider Information

NPI Number	:	1093255010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVE GIRLS ON FYER INC

Provider Business Mailing Address
First Line	:	276 HIGHLAND AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3022
Country	:	US
Telephone Number	:	203-596-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	276 HIGHLAND AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3022
Country	:	US
Telephone Number	:	203-596-0700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	JACQUEE PORTER
Credential	:
Telephone Number	:	203-596-0700

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	02/24/2017

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